top of page

Appointment Request Form

Please complete the form below to submit an appointment request with Dr. Dapul-Hidalgo. After your form is submitted, our team will review the information and call you within 1 to 2 business days (between 9 AM - 6 PM) to complete your appointment request. Thank you.

​

IMPORTANT NOTICE: If you require emergency medical care, please call 911. This form is for non-urgent appointment requests only.

Patient Information

NOTE: With this form, you are submitting a request for a callback for a non-urgent appointment request. Our team will contact you to facilitate scheduling an appointment within 1-2 business days. Calls are made Monday through Friday between 9 AM and 6 PM.

Thank you for submitting!

bottom of page